TUMOR DAERAH LEHER

KISTA DUKTUS TIROGLOSUS

SISA PROSES PERTUMBUHAN
KEL. TIROID.
SERING DITEMUKAN PADA USIA
2 7 TAHUN
LOKASI, MID LINE ,KRANIAL TIROID
HINGGA PANGKAL LIDAH

KLINIS
DAPAT BERUPA KISTA, SINUS DAN
FISTULA.
BILA BERHUBUNGAN DENGAN RONGGA
MULUT SERING INFEKSI
> 75%, DIDAPATI HUBUNGAN DENGAN
PANGKAL LIDAH, SEHINGGA BILA
DISURUH MENJULURKAN LIDAH MASSA
IKUT BERGERAK KE ATAS.

KLINIS
BISA TERJADI RADANG AKUT
BILA LOKASI DEKAT PANGKAL LIDAH
DAN SANGAT BESAR DAPAT
MENIMBUKAN, DISPAGIA, DISFONI,
SESAK NAFAS, PERDARAHAN DAN
SAKIT.
FISTULA DAPAT TERJADI SPONTAN ATAU
AKIBAT INSISI ABSES,

DIFERENSIAL DIAGNOSA

PEMBESARAN KEL. GETAH BENING

KISTA DERMOID
PANGKALLIDAH:LINGUALTONSIL,
FIBROMA, ANGIOMA, SARKOMA /
CARSINOMA LIDAH

PATOLOGI
DAPAT DIJUMPAI JAR. TIROID
EPITEL, BISA SKUAMOSA DAN
KOLUMNAR

TERAPI
INFEKSI AKUT, KOMPRES LOKAL DAN
PEMBERIAN ANTI BIOKTIKA.
ABSES, DRAINASE
MASSA, EKSISI.
OS HYOID HARUS IKUT DIEKSISI.
EN BLOK SAMPAI PANGKAL LIDAH.

KISTA BRANCHIAL
KELAINAN DAPAT BERUPA, SINUS,
KISTA, SISA TULANG RAWAN & FISTEL
DILEHER.
SISA CELA KANTUNG INSANG .
DILAPISI SEL EPITEL SKUAMOSA.

KLINIS
SINUS & FISTEL DIJUMPAI ANTERIOR
DARI M STERNOKLAIDOMASTOIDEUS.
DAPAT DETEMUKAN WAKRU LAHIR DAN
SERING PADA USIA 10 TAHUN.
SERING HANYA PADA SATU SISI,
BILATERAL DITEMUKAN PADA 10 %
KASUS.

DIFERENSIAL DIAGNOSA

LIMFADENITIS GRANULOMATOSA.
HAEMANGIOMA, HIGROMA KOLI.
KAROTID BODY TUMOR.
LIMFOMA.
METASTASE PADA KGB.

TERAPI
INFEKSI AKUT, KOMPRES DAN BERI
ANTI BIOTIKA.
ABSES, DRAINASE.
KISTA, EKSISI.

LIMFANGIOMA
DISEBUT JUGA HIGROMA SISTIKA ATAU
HIGROMA KOLI.
TUMOR JINAK SISTEM LIMFATIK.
DIJUMPAI SEJAK LAHIR, TERUTAMA
DATANG PADA USIA 1 2 TAHUN.
DAPAT DETEMUKAN PADA SELURUH
TUBUH, SERING DI LEHER DAN AKSILA.

KLINIS
KISTIK, LUNAK DAN TRANSILUMINASI &
BERLOBUS LOBUS.
PADA BAYI BARU LAHIR DAPAT
DITEMUKAN PADA SELURUH LEHER,
LIDAH, LARING DAN MENGGANGGU
JALAN NAFAS.

HISTOPATOLOGI

SIMPLE.
KAVERNOSA
KISTIK

TERAPI
PEMBEDAHAN, BERUPA EKSISI, PADA
USIA YANG TEPAT.

PARATHYROID
Development
Superior glands develop from fourth pharyngeal pouch.
Adult position fairly constant with respect to the superior lobes of
thyroid
Inferior glands develop from third pharyngeal pouch, in conjunction
with thymus
Inferior glands have more variable position (intrathymic or even
superior to superior glands)

Anatomy
Weight <50 mg/gland
3x3x3mm
Yellow-brown tissue similar to surrounding fatty tissue
Histology : Normal gland contains mainly chief cells, with occasional
oxyphils
Vasculature : Inferior thyroid arteries ; superior, middle, and inferior
thyroid veins
Physiology / Calcium Homeostasis
Primary function : Endocrine regulation of calcium and phosphate
metabolism
Regulators of calcium and phosphate metabolism : Parathyroid hormone
(PTH), vitamin D, calcitonin
Organ systems involved : Gastrointestinal (GI) tract, bone, kidney

PTH
Synthesized in precursor from by the parathyroids .
Calcium levels requlate secretion of cleaved PTH (with negative feedback mechanism)
Bone :
Stimulates osteoclasts
Inhibits osteoblasts
Stimulates bone resorption, releasing calcium and phosphate
Kidney :
Increases reabsorption of calcium
Increases phosphate excretion

GI tract :
Stimulates hydroxylation of 25-OH D
1,25 OH D, then increases absorption of calcium and phosphate
Promotes mineralization
Enhances PTHs effect on bone
Calcitonin
Secreted by thyroid C-cells
Inhibits bone resorption
Increases urinary excretion of calcium and phosphate

Hyperparathyroidism
PRIMARY
Due to overproduction of PTH, causing increased absorption of calcium
from intestines, increased vitamin D3 production,
and decreased renal calcium excretion, thereby raising the serum level.
Incidence : 1/800 in the United States
Signs and symptoms :
Stones : Kidney stones
Bones : Bone pain, pathologic fractures
Groans : Nausea, vomiting, constipation, pancreatitis, peptic
ulcer disease
Moans : Lethargy, confusion, depression, paranoia

Etiology :
Solitary adenoma 85-90%
Four-gland hyperplasia 10%
Cancer < 1%
Preop localization : US, FNA of suspicious US findings, Sestamibi
scan
Diagnosis : Elevation of plasma PTH, with inappropriately high serum
calcium
Treatment :
Solitary adenoma : Solitary parathyroidectomy
Multiple gland hyperplasia : Remove three glands, or all four with
reimplantation of one gland in forearm
Outcome :
First operation has 98% success rate
Reoperationhas 90% success rate if remaining gland is localized
preop

SECONDARY
Due to chronic renal failure or intestinal malabsorption that causes hypocalcemia
with appropriate increase in PTH.
Signs and symptoms :
Bone pain from renal osteodystrophy and pruritus
Patients are often asymptomatic
Diagnosis : Made by labs in asymptomatic patient
Treatment :
Nonsurgical : In renal failure patients, restrics phosphorus intake, treat with
phosphorus-binding agents
and calcium/vitamin D supplementation. Adjust dialysate to maximize calcium
and minimize aluminium
Surgical : Indicated for intractable bone pain or pruritus, or
pathologic
3-gland parathyroidectomy

TERTIARY
Due to autonomously functioning parathyroid glands, resistand to
negative feedback, for example, persistent
hypercalcemia following renal transplantation
Usually a short-lived phenomenon
If persistent, surgery is indicated (3-gland parathyroidectomy)

Hypoparathyroidism
Uncommon
Etiology :
Surgical-induced : Usually following total thyroidectomy ; usually
transient and treated if symptoms develop
Congenital absence of all four glands
DiGeorge syndrome : Absence of parathyroids and thymic agenesis
Functional : Chronic hypomagnesemia

Signs and symptoms :

Numbness and tingling of circumoral area, fingers, toes
Anxiety, confusion
May progress to tetany, hyperventilation, seizures, heart block
Treatment : Supplementation with calcium and vitamin D
Pseudohypoparathyroidism : Familial target tissue resistance to PTH.
Patients remain hypocalcemia and hyperphosphatemic despite bone resorption from elevated PTH. Treatment
consists of calcium and vitamin D Supplementation.

Parathyroid Cancer
Signs and symptoms :
Forty to 50% present with firm, fixed mass
Extremely high calcium, PTH, and alkaline phosphatase
Also associated bone disease, renal insufficiency, and renal stones
Pathology :
Pale, white, adherent mass, with a thick fibrous capsule and septa
Enlarged hyperchromatic nuclei and varied nuclear size
Treatment :
En block surgical resection of mass and surrounding structures, ipsilateralthyroid lobectomy, regional lymph
nodes
Postop external radiation therapy (XRT) and chemotherapy are not usually beneficial
Five-year survival : 70%

MULTIPLE ENDOCRINE NEOPLASIA

(MEN)
General

Autosomal dominant disorders resulting in

multiple (metachronous or syn-chronous)
tumors in different endocrine organs.

MEN I
Chromosomal defect : 11q12-13 (deletion)
Pituitary adenomas
Parathyroid hyperplasia
Pancreatic islet cell tumors
Involvement :
Two glands : 50%
Three glands : 20%
Age at presentation :
Without known affected family members : 20s to 30s
With known affected members : Prior to age 20 (through
screening)

MEN IIA
RET oncogene mutation on chromosom 10q11.2; missense mutations on chromosome 1
Parathyroid hyperplasia
Medullary thyroid carcinoma
Pheochromocytoma

MEN IIB
RET oncogene mutation on chromosome 10q11.2
Medullary thyroid carcinoma
Pheochromocytoma
Mucosal neuroma
Mafanoid habitus

TERIMAKASIH